Site Info

The Accidental Cyborg

Let me tell you, being a cyborg isn't all it's cracked up to be. But it might be, sooner than you expect.

The popular image of a "cyborg" may be mash-up the character from Teen Titans and the Six Million Dollar Man (the balance of each depending upon how old you are), but the reality is not nearly so exciting. The truth is, we've had people with cybernetic prosthetics for quite some time, and the number is growing quickly. They're not action heroes (by and large), they're people all too often casually dismissed as "disabled."

But the demographics of the disabled are changing, as is the power of assistive technologies. And these changes have serious implications both for the role and visibility of the disabled in Western society and the ongoing debate between augmentation as "therapy" and augmentation as "enhancement."

I speak from personal experience on this one; I recently joined the ranks of the cyborgs. A few years ago, after noticing that my hearing seemed degraded, I saw an audiologist. His diagnosis wasn't encouraging: definite hearing loss, most likely congenital and almost certain to continue to degrade. At that point, it wasn't quite bad enough to require hearing aids. I went in for a new examination last month, and got the news: I really should be using hearing aids, at least if I wanted to stop annoying loved ones, friends and colleagues with my incessant "excuse me?" and "I'm sorry..." requests for repetition. After a few fittings and follow-ups, I got my new hearing assistance devices this week, and I'm wearing them right now.

These aren't just dumb amplifiers; they're little digital signal processors, small enough to fit into the ear canal, and smart enough to know when to boost the input and when to leave it alone. They're programmable, too (sadly, not by the end-user -- programming requires an acoustic enclosure, not just a computer connection). And here's where therapeutic augmentation starts to fuzz into enhancement: one of the program modes I'm considering would give me far better than normal hearing, allowing me to pick up distant conversations like I was standing right there.

They're not without their drawbacks. They're somewhat uncomfortable -- not painful, but impossible to ignore. The quality of the sound I get through the devices will take some getting used to; the size of the speaker limits just how clear the sound can be, I'm told. And, as far as I can tell, the electronics in these things change very slowly, Moore's Law be damned. I think there's a generational issue here: up until recently, most people wearing hearing aids came from the pre-computer era, and expected to pay outrageous prices for technologies of a just-good-enough quality (especially medical technologies). As more Baby Boomers -- and those of us younger than the Boomers -- start to require augmentation technologies, the manufacturers will increasingly see demand for greater quality and faster improvement.

A few hearing aid companies are beginning to see the light. Oticon, for example, offers a model of hearing aid with built-in bluetooth to make mobile phone calls easier. They don't come cheap, though -- just about $3,000 per ear. The first hearing aid company to act like a computer industry player instead of a medical tech industry player will make millions from the aging-but-tech-savvy.

The transformation of augmentation technology from pure therapy to a mix of therapy and enhancement is more visible in other types of prosthetics, however. Both New Scientist and the New York Times had recent articles about the remarkable capabilities of new prosthetic technologies, with a particular focus on cutting-edge models of artificial legs. In New Scientist (subscription required), the focus is on digital prosthetics offering new ways to compensate for disabilities:

[MIT researcher Hugh] Herr, who has made it his life's work to design improved prosthetic legs, is being funded by the US Department of Veterans Affairs to work on a prosthetic ankle that returns more energy in each stride. Inside each prosthetic are battery-powered motors that do a similar job to muscles. Last week, he wore two of these brand-new ankles for the first time. "It was absolutely amazing," he says. "It's like hitting the moving walkway at the airport." People wearing the new prosthetic have been shown to expend 20 per cent less energy when walking than with a standard prosthetic, and Herr says their gait also looks completely natural.

(Note the mention of the Department of Veterans Affairs. The Iraq War has become a significant catalyst in the rapid improvement of prosthetic technologies. The vast improvements in battlefield medicine that allow far fewer casualties to die have correspondingly meant that far more casualties come back with significant disabilities, including limb loss. As of January, 500 soldiers had undergone major amputations, a rate double previous wars.)

The sports implications of these new prosthetics haven't gone without notice. As the New York Times describes, South African Oscar Pistorius runs fast enough on his unpowered carbon fiber artificial legs that he's in contention for the 2008 Olympics -- if the International Olympics Committee will let him in. The IOC fears that continued advances in prosthetic technology will lead to "disabled" runners beating the all-natural runners in the not too distant future. They're right to be concerned; the most compelling part of the New Scientist article had to be this brief section:

Herr mentions a 17-year-old girl who has decided to go ahead with an operation to amputate a damaged leg because, he says, she thinks a new prosthetic will give her more athletic ability than she has now. For his own part, Herr claims he would not swap his prosthetic legs for natural legs, even if he could. "Would you buy a computer system if you were told you couldn't upgrade it for 50 years?" he says.

Herr's comment is eerily similar to an observation I made about why implanted computer systems were unlikely. We've seen such remarkable change in computer technology is such a short time, it's hard to imagine wanting to remain stuck with a rapidly-obsolescing model. But in a world of augmentation, is the biological body just another dead-end technology?

Or, to make this more personal: I expect that, over the next decade, hearing aid technologies will have improved enough that most of the drawbacks will have been rectified, and I'll have access to hearing capabilities better than ever before; over that same time, we may see biomedical advances that can fix deficient hearing, restoring perfectly functional natural hearing. Augmentation for therapy slides inexorably into augmentation for enhancement. Should I give up my better-than-human hearing to go back to a "natural" state?

This changing perception of both disability and augmentation can be summed up in this amazing picture of Sarah Reinertsen, taken by Stephanie Diani for a Timesarticle about prosthetic fashion (and I strongly encourage you to click through to the full-size picture). Her artificial leg has no pretense of biology, yet is clearly part of her. It's not simply a prop to help her live a just-good-enough life; it's an augmentation that will only get better as the months and years pass. I doubt she looks with envy at the women with two "normal" legs on the dance floor; I suspect we're not too far away from a time when those women will look with envy at her.

You've just written the "hearing aid" story I've been waiting for. I used to talk to my dad about this all the time— he died last fall— because we knew that if he lived long enough, these pathetic hearing aids and their ridiculous costs would be scattered to the winds.

How does your new ear function in crowded rooms, like restaurants? That's what I hear is the most annoying, when you're trying to separate your companions voice from all the high pitched racket.

Hearing aids are a racket. Insurance won't cover them, even for people with documented hearing loss. They're crazy expensive. As far as I can tell, they're HUGE profit makers, for all parties involved.

I have hearing loss. I got hearing aids a couple of years ago, at least for a while. My expeience left me disgusted with the whole industry. Even if these things have the most amazing chips, battery, spekaer and microphone in them, they can't cost more than $100 each to make. Throw on four times that for design and engineering costs, and you're still at $500 each. There is a huge range of profiteering between that and the price an audiologist sells them for.

I hope what you predict is true, because I just can't fathom paying such an outrageous amount of money for such a simple thing. These things have basically the same type of DSP that have been in digital cell phones for years. My cell phone cost me under $100, and I an program it myself. Why on earth can't I do that with hearing aids?

I'm hearing impaired myself, and have been living with hearing aids since I was about 6.

I have to say with these new digital hearing aids (which I got about 3-4 yrs ago) that sound quality, especially in concert settings, really suffers. I get nothing but distortion in concert halls (and this is from the supposed Cadillac of aids). I just end up pulling them out entirely which doesn't make things sound much better. :-/

I'm wondering if the new aids out today have much improved over these...I'm thinkin probably not, considering the industry caters to the elderly and not to those of us in our 20s and 30s. :-/

Unfortunately, your hearing loss has a greater impact than just not being able to hear soft sounds. A hearing aid can never return your hearing to "normal" due to the physiological changes that have occurred in your inner ear (eg to discriminate between two very similar frequencies). The greatest obstacle to enhancement (ie. better than normal) will be overcoming the loss of these associated natural abilities. Even if you use a computer to understand speech in noise, how will it determine whats important? The fire siren? Your wife? The TV?

Whilst you may want "super-ears", you'll soon get sick of that person stirring their coffee 5 tables over or the cook pummeling the steak out the back!! Hearing aids are designed for conversational distances.

A great idea. I have a hearing loss from birth (I'm 36) and my older model, though it was state of the art a decade back, doesn't do enough. I'd love to dine out and attend parties without hearing the crowd surf noise, over which you can't hear people talking.

You didn't mention what model of hearing aids you got. The technology over the past five years has come a remarkably long way, from analog devices with pots that you had to turn with screwdrivers to adjust 'high frequencies' and 'low frequencies' to unbelievable signal processing.

You have in-the-canal aids. They're great and low-profile, but the technology available in behind-the-ear aids is even more amazing -- greater amplification, because the mic is farther from the speaker. Also, earmolds for BTE aids can be made of several different kinds of materials (including soft silicone) to make them more comfortable.

Was recently discussing augmentation on my blog. Proved an unexpectedly popular topic. Shouldn't have, I suppose. In virtual worlds it's all about the avatar; in the real world it's all about the body.

My daughter just turned 4 years old. She has had hearing aids since she was 6 months old (diagnosed with sever hearing loss),and has speech capability's nearly on par with her peers.

What does augmented hearing mean in an age when it's now software - not hardware doing the signal processing? How long until both the hacker generation, and the kids that follow them start fiddling with their own ears, and start tuning them to pick up sub-aural and infra-aural sounds? My daughters (Oticon) also will work with bluetooth, wireless FM transmitters (for school) and a host of other plug ins... lucky she wasn't born 50 years ago.

Thank you all for your comments. I was surprised when David posted this to BoingBoing, but very pleased at how much the story seems to have connected with people.

I'll try to answer questions as I can. One point I should clarify: the "super-hearing" mode will be a separate programmed mode, not the normal operating mode -- the model I got allows for 3 different settings.

Susie (I'm a big fan, btw): under the normal setting, the hearing aids are no help; with the "crowds and restaurants" setting, though, which suppresses lower-frequency sounds, it becomes easier to hear the people you're sitting with.

Justin: I hear you (um, as it were). The hearing aid industry is used to the medical tech market, which is much more tolerant of massive prices than is the infotech market -- but as hearing aids become just another form of infotech, they'll be in for a bit surprise when Sony or Apple comes along and eats their lunch.

Adam: I suspect you're right.

David: To be clear, the "super hearing" is an optional setting, not the default.

Sara: I suspect that we'll get those kind of glasses-with-subtitles sooner than we'll get the hearing aid companies to join the 21st century.

Julien: Thanks, I will.

Kerri: I have "Audio Star" digitals, and I know they aren't as good as the Oticons. They were, however, affordable (and even so, were outrageously expensive). I consider them my starter hearing aids, though, and expect to move to devices that serve my needs better in the next few years.

Sven: I didn't ask, but considering they took ten days to go from mold fitting to production unit, I really doubt they were rapid-fabbed.

I just got a set a few months back, specifically a pair of behind the ear Siemens ACURIS Life aids. They are not cheap ($1950 each or so), but they make such a huge difference in my life that the cost was well worth it. I am a BIG fan of behind the ear ones now, having formerly had in the ear ones.

Pre-hearing aids, I used to find work and general social interaction very difficult at work and elsewhere, and in fact found it easier to just avoid socialization to avoid the frustration. There is a definite and interesting psychology to how hearing loss affects people, moulding their social interactions (or lack of) and their behavior. It's easy to answer questions inappropriately when you aren't sure of the question but are too embarassed to say, "What?" again for example. It's easy as well to dominate a meeting because it's easier to know what's going on if you are leading than if you are following (and not hearing). It's easy to spend most of your energy trying to just comprehend the thread of a conversation and not spend it actually participating or thinking about what's been said.

It really really warms my hear to see how hearing aids are becoming more main stream now. What I'm waiting for next is the advent of the stylish hearing aid. When I got mine, I could choose from a variety of "natural" colors that basically matched hair colors - like I want to hide them. Heck I'd gladly pay more money for ones that were chrome or even optionally glowed. I WANT people to know I have hearing aids because I sometimes need to get people to speak up, and people in general aren't very responsive to the request because they don't see any signs of the hearing loss. People with glasses clearly need vision aids, people in wheelchairs clearly aren't about to go running up the stairs.

Basically, as I see it, someone with some hearing loss (not profound) is a lot like someone who needs glasses. It's not a big deal to wear glasses, and it shouldn't be one to wear hearing aids. You can get by without glasses, but it is neither a joy nor an easy prospect. The same goes for hearing loss. It impacts your personal life, your social life, your emotional well being and your work productivity. If you want to look at it from the dollar point of view, one would not expect workers to be productive without glasses, and one can hardly expect those with hearing loss to be productive without hearing aids.

And yet often insurance coverage is horribly out of sync with reality. The State of Oregon until recently only offered $500 every few years for hearing aids. That's total, not per ear. You basically can't GET $250 hearing aids and even if you could find them, they would be technologically ancient and potentially worse for your hearing than wearing none at all. $500 is like offering someone $5 to cover glasses, or buying someone without a leg a cane or crutches. But there is hope, as some states and some larger organizations do provide (or mandate) better coverage levels. I was recently involved with others here in Oregon to lobby the public employees benefits board to raise the coverage for state employees, which they did - from $500 up to $4000. Now that is more like reality, as expensive as it is!

The thing to keep in mind about hearing loss is that it's not an "old persons" issue. It's a kids issue too and a working age person's issue as well. If you're looking for more statistics on hearing loss, see http://www.nidcd.nih.gov/health/statistics/hearing.asp and http://gri.gallaudet.edu/Demographics/factsheet.html or just Google for "hearing loss statistics".

So three cheers to you Jamais for helping elevate the education, interest and awareness!

I was fitted with a pair of expensive in-the-canal hearing aids a couple years ago, and I was disappointed with the high cost vs. their actual day-to-day utility.

While the active noise-cancelling mode helps in certain situations, in restaurants they're almost useless. What nobody mentions is that these hearing aids conduct noise from the jaw bone so that it's like living that Raisin Bran Crunch commercial where all the guy hears is his own chewing. So in restaurants I can either listen or eat, but not do both at the same time.

I also find my custom in-the-canal hearing aids become uncomfortable after a couple of hours. My ears feel stuffy, hot and humid if there's any exercise involved. In the end, it's such a relief to take them out that I usually only wear them when I absolutely have to.

If I do get another ser of hearing aids, I would definitely go Tim's direction and get a set of over-the-ear units. Not only have many people considered them more comfortable, but I think I'd prefer a more conspicuous design. I don't need to hide my hearing loss, in fact I would rather remind people that they were speaking with a hearing impaired individual.

Thank you, Jamais and the other commenters, for voicing issues about hearing aids that need to be heard more often.

I'm quite curious as to the description of the in-ear hearing aids. I have a set of in-ear headphones that conform to my ears by using a disposable pad of "memory foam" to fill the ear canal, with a hard plastic channel down the center for sound conduction.

This leaves the mechanics of the earbud mostly just outside the ear canal (which may be undesirably prominent), but I find it extremely comfortable to wear for 8+ hours. This looks to be better than the 4 and 5 hours I'm hearing for the rigid in-ear aides AND the squishy memory foam doesn't require custom fitting. My headphones came with three sizes of pads so I could pick the ones that best fit my ears (in my case, the large ones).

The pads in my headphones are designed to block background sounds and comfortably anchor the headphone in the ear. I suspect the first wouldn't be an issue with hearing aids, but the second would.

I find the pads need to be replaced every month or 6 weeks, but I can buy six for about 20 dollars over the internet.

I understand that hearing aides have more electronics to tote around than my headphones, but I'm wondering if a foam "sleeve" or similar arrangement around the aide might suit some people better than the harder plastic molding. It would be vastly cheaper and much quicker to "fit" to the patient (30 seconds, really) than trying to shape something exactly to your ear canal...

I'm so sorry I didn't read this site before I got my hearing aids a few months ago. I spent a lot of time on line looking for a site that would do a Consumer Reports-type comparison but I couldn't find one. I ended up going to my local shop because I liked the guy. He has worked hard with me trying to get the hearing aids just right, but I too am annoyed by my own chewing and breathing, etc. Computer motors are incredibly loud. I got the hearing aids because I thought it would help me hear my husband and my boss better. It doesn't help with either. But my husband has learned to talk louder and slower.

I have severe hearing loss in both ears (worse in my right) due to nerve damage, probably genetic.

I am currently wearing digital, programmable aids in both ears. Mine are probably similar to yours but larger and slightly more uncomfortable. I have problems with feedback sometimes when I brush up against things or when people hug me, which can be kind of embarrassing and inconvenient.

I have a love-hate relationship with my aids, which are now a few years old and tend to conk out every now and then. They do undoubtedly allow me to hear many things I would otherwise miss, but I still miss enough that the concept of "enhanced" hearing is completely abstract and beyond my grasp. I'll believe it when and if I see it, but for now I still struggle every day (phones are the worst, both cell and regular).

The designer of the woman's leg in the picture is a genius. Robolimb functionality, but a full silicon foot for those cute slingbacks. I don't know of many women who would accept anything less.

I think the most interesting application of completely programmable hearning aids will be the ability to perceive additional data channels. Maybe my GPS plays music coming from the direction I want to go, or my iPod directly pumps my MP3s into my hearing aids.

Jamais, you make an interesting point about implants, but if your hearing loss was due to mechanical damage to your ear bones, wouldn't you want a direct interface to your auditory nerves? Obviously you'd want an open, upgradeable platform for that, but you'd want a direct hardware / wetware connection.

Great article, Jamais, and lots of really great comments here (I'm here from boing boing). I know I have terrible hearing loss, mostly (I assume) from being part of the "walkman generation" (if its not loud music, its not good music) and from spending too much time in nightclubs in my youth. I've been agressively avoiding even going to an audiologist for fear they're going to tell me I need hearing aids, and I don't want to wear them, because I have Fear of Being Old. But I'm starting to have so many social problems with not being able to hear well, constantly having to ask people to repeat themselves, that I may be forced to go atfer all. I dread it.

I love love love the idea Tim said about hearing aids in chrome, or that glow. Make them in colors! Make them look like the bluetooth mics everyone wears these days! I would so buy that.

I've been using BTE aids since age 13 (now 44) in just one ear because the right ear is completely gone. Although I have 2 excellent digital aids, I've continued using an ancient analog model because digital aids make a hash of music. They do this because the DSPs are tuned to the range of speech, so some ranges in music are simply suppressed. Audiologists have told me that it's possible to program one of the digital hearing aid channels to an "analog" mode. I'm skeptical, but haven't had a chance to check this out yet.

Jerril, the foam sleeve idea is a good one, but they would of course need frequent replacement, because they'd collect odor and bacteria from sweat, hair oil, etc.

The hearing aid business IS a racket, no question about it. I discovered that you can't resell used hearing aids - eBay won't even accept ads for them. It's high time to bust the audiologist/manufacturer monopoly and expose the field to genuine competition.

Tim, thank you, and thanks for the link to the stats. I think you're right that BTE is the way to go -- I suspect that my next pair will take that form.

Rick -- oh, man, you're absolutely right about the sounds while eating. I asked my audiologist about that today, and his reply was:

"Well, you'll laugh, but the reality is that you eventually learn to eat *around* the conversation..."

Jerril, I think your example is just the kind of thing we'll start to see when gadget & computer manufacturers start to pay attention to the soon-to-grow-rapidly hearing aid market.

Dena -- the feedback is really bothersome, and I still tend to get it as I'm putting in the units.

Jason: in principle, sure, I'd want the direct to nerve system, but the upgradability aspect is important. In my piece, I was talking about non-therapeutic implants, though, and there I find the argument for implantation to be less tenable.

Laura: thank you! The only downside to the bluetooth phone headset model is needing to wear them on both ears -- you go from looking like dot com 2.0 to looking like Lando Calrissian's assistant.

Thank you so much for blogging about this. I have low-frequency hearing loss that is congential + self-imposed damage from years hanging out near the speakers at rock shows every weekend.

I looked into getting hearing aids about 5 years ago, as I was told I needed them for both ears, but struggled with the whole idea of havign them to begin with-some of it was vanity, some of it was acceptance of my disability.
I've had so many other un-fun things in my life, that this just seemed to be the icing on my cake.

My friends & family know I like my tv loud, but at work it is rough when I have ask people to repeat themselves. I've become good at reading lips & just nodding.

Your post has inspired me to at least get back into researching how I can afford to pay for them & also it looks like I could feasibly get over my stupid vanity issues as they seem like they are hidden well. I recall the digital ones I looked at in the past had a little clear wire that stuck out.

That's the story of my life, basically, although I've been aware of my hearing loss since childhood, and now it's so bad I'm required to have the behind-the-ear models, and turned up too. In-the-ear ones would be useless. My entire ability to be social is dependent on them, as I'm basically a deaf person when they're out or turned off; conversely, when they are off I get total peace and quiet.

Here's a major tip, Jamais, (and anyone else with hearing aids) about dealing with listening to music -- have one of the programmable modes set to have the noise suppression function (essentially "compression" in recording studio parlance) completely turned off. All of the frequencies of music will then sound relatively authentic and unadulterated instead of modified by the electronics. I have the compression on my BTEs (which only have one programming mode) set to off at all times and music sounds better than ever.

I think the prospect of augmentation devices becoming “better than normal” is fascinating and full of many practical and philosophical questions. But I honestly think that we’re very far from that with hearing devices. And the main problem is not the technology, but the complexity of the auditory system and the damage that occurs in what we call “hearing loss.” As David alluded to, typical deterioration of the inner ear impairs much more than the ability to detect soft sounds. The neural encoding of frequency, timing, amplitude, and even signal onset and offset are all compromised by inner ear damage. These problems are then compounded as the signal ascends the brainstem and cortex, with contralateral and ipsilateral neural connections at multiple levels.

That’s not to say the hearing devices are worthless or of no help. Quite the contrary, I have many patients who tell me that hearing devices have greatly improved their lives. Moreover, research by Sergei Kochkin of the Better Hearing Institute demonstrates that hearing impaired people who wear hearing devices experience significant improvement in emotional, psychological, and physical health, not to mention improved communication. It’s just not the same as normal hearing.

The rate of improvement for hearing assistive technology has increased greatly. When I first became an audiologist, hearing aid manufacturers would develop new models every 3 or 4 years. Now the rate is about every 18 months. And the focus of development is not primarily for the elderly. Just look at marketing materials for some of the most advances products, such as the Oticon Delta, Oticon Epoq (the one that’s Bluetooth compatible), or the Phonak Audeo. Indeed, 65% of hearing impaired people in this country are under age 65. The developers and manufacturers know this, and hundreds of millions of dollars are going into research to meet their needs.

The financial cost of hearing devices is a huge issue. But the practitioners in our field are not getting rich (as an Audiologist with a doctorate and 10 years experience, I earn less than a software engineer just out of college with a BS). Yes, the medical device manufactures seek to earn a profit on their products, but they also incur the risk and the high cost of research (that exciting Oticon hearing device that’s Bluetooth compatible has over 450 man years of research involved) and there is only a limited number of units sold for them spread that cost across.

I agree that the lack of insurance coverage is a crime. If you care to get involved politically, one small step that we’re pushing for currently in the House and Senate is a $500 tax credit for the purchase of hearing devices. Check out http://www.betterhearing.org/press/articles/pr_TaxCredits.cfm for how you can help.

Unfortunately, for those with more severe loss, it's either expensive hearing aids, or nothing. I really doubt that in 10 years technology will catch up. In the last 10 years it certainly hasn't gotten that far. I suspect it will be beyond my lifetime that technology will catch up to the level of hearing loss that I have. I've never been a candidate for ITE hearing aids, as only BTE provide anywhere near enough power of amplification, and the ones I need are the "fancy" ones simply because of the power needs. Several grand each, which are out of my ability to pay, so I simply go without haring aids. It's nice to see someone so excited and positive about new hearing aid technology, and it will be sad when the reality of the limitations hits you. Yes, I know you know of the limitations, but you haven't reached them yet in the aids. When it's a choice between eating and hearing aids, you'll pick eating every time.

A few things in response to other's comments: the person who gets feedback upon hugging. I bet it's the kind of mold you have. There's a style of mold that fits your ear like a plug with no portion sitting in your outer ear at all. This additionally comes in two types. One is more hollow, like if you took a piece of highly flexible rubber and pushed it into your ear. it's just a thin outer shell with the tube glued into the end. This one sucks, it breaks easily, the tube pulls out easily, don't get this one. The other kind is like a solid ear plug, so you have more of the tube set into the mold material. The former you have to grab the edge of the mold and pull that out, the latter you can just pull on the tube like you would with a regular mold. Because it fights tightly into your ear canal and it doesn't get moved about by pressure on your ear, this kind results in almost no feedback whatsoever. You can even lie down and rest your head on your hand by your ear without triggering the feedback.

The other person who said about colors of hearing aids: They already exist. Blues, reds, pinks, purples. You can also get your earmolds colored, similar to how dental retainers are colored. You can even get them colored like a watermelon. Just ask your audiologist next time about the colored molds since you'll be replacing those long before you'll replace the hearing aid itself.

Now that I'm disabled by a car accident on top of the hearing loss, I'll probably never have enough money to get the hearing aids that I need, which is a damn shame. But that's life for you. The ones who need the aids most are often the ones who can pay the least, because of the expense of the aids.

Strictly speaking, if you were to turbo-up your hearing aids & attempt to use them to listen to otherwise private conversations, you’d be committing a federal felony.

Under U.S. law, it’s generally illegal -- with certain exceptions, such as court orders or party consent -- to eavesdrop on private “oral communications.” Oral communications are defined in the statute as, in effect, those subject to a reasonable expectation of privacy. A chat in a crowded elevator gets no protection; ditto for an amplified speech on a public street; but two people sitting alone on a park bench, away from others & conversing quietly, enjoy legal protection.

To violate the law, you have to use an “electronic, mechanical, or other device.” The definition for that term explicitly excludes hearing aids and similar devices, but only when they are “being used to correct subnormal hearing to not better than normal.”

I totally agree with you on the cost of hearing aids, the technological changes and implants.

I lost my hearing at age 13 (now 27) and have had my current digital aids for 5 years. I have money in a flex plan to get new aids this year (or maybe just 1 since they are so expensive) but the doctor keeps pushing for a cochlear implant instead. I'm not interested. It's an irreversible process that destroys the hearing I have left. Even if they tell me that my hearing isn't doing me much good...

I believe that there will be something better. It will be totally different and it will happen long before they perfect the hearing aid.

One thing about implants: if it's a pain for users to change them, then it's also a pain for others to.

There's no policy for implants in prison. If it requires surgery to remove something, is it within the rights, to say nothing of the capabilities of authorities to remove it? If my panopticon node is implanted, it can't exactly be confiscated, can it?

My PC is seven years old. It works fine. At some point, industry is going to start losing the ability to wave the upgrade carrot. It did for me years ago. The same could happen to implants - especially if the logistics of surgery remain expensive enought o keep it a luxury (malpractice, anyone?).

your hearing aids look cool, and i guess thats important, but wouldn't there be an advantage to get a bigger model with better electronics?

i'm concerned because i think most people make the wrong decision when purchasing hearing aids, caused by what basically
amounts to a case mistaken vanity , and i think your post will encourage this even more.

if in the end what you got doesn't really work, i hope you post a followup saying that if you had to do it all over again you'd go for one of the bigger models.

my personal experience in this regard is with my dad. we didn't have much luck with hearing aids, but i wound up buying a $170
wireless bodypack microphone and receiver with headphone out. sure its a little goofy looking, but we can now hold a conversation in even challenging situations like restaurants or out riding our bikes, with better performance than
we previously had with hearing aids when indoors with no background noise. this was with no "training", no "break-in" period, just straight out of the box. other benefits of this solution are no feedback (caused in normal hearing aids since the microphone is so close to the speaker), and no weird noises when chewing or swallowing.

as an aside, would an audiologist ever suggest this as say just one tool that a hearing impaired person could use to communicate with their loved ones? of course not, since it would not be possible to mark up the price on this item enough to compensate for their time.

this is a shame, and shows that the hearing industry is not currently structured to serve the best interests of hearing impaired people.

Jonathan, for what it's worth, I went with the one the audiologist I saw recommended.

Sara, I can entirely understand your reluctance to go the cochlear implant route. I would caution, though, that it may be quite some time before the better augmentations make it through FDA approval once they're invented, so don't hold off getting something you need now in hopes of getting something better at some point in the future.

Thanks for the info, eck.

Natalija, thank you for the insights -- and I'm sorry that things aren't going better for you.

Libby, thank you for the audiologist perspective. For what it's worth, I never suspected that the audiologists were making out like bandits in this. I'm not overly concerned that the hearing aid makers are making too much money, I just think they're stuck in a production model that's inappropriate for the technology field. As I suggested, I'd really be curious as to what a real consumer electronics company would do with a hearing aid.

Jamais, I hate to gush, but you changed my life. I read the boingboing of this post, which inspired me to go see the audiologist for the first time. I had been putting it off for months. I'm going to need a hearing aid or surgery soonish and the conversation here has sparked me off to make a bigger, better research project out of the quest to maintain my hearing. Big love, Beth

this is the second time i read your post. months ago i didn't have aids, and now i do, ITE siemens models. it's been three days.

i've learned how much sound i've been missing over the years. the aids help conversation so much it's crazy (high tones were previously masked by tinnitus), so it's a breath of fresh air in that sense.

the surrounding sounds are a bit weird... their amplification, although sold as being "smart", isn't entirely that smart. i suspect some of it can be fixed with programming, but i'm intrigued by all these people that are talking about BTE models now. i may exchange them, to see how it is with the other models. i know the Phonak Audeo has anti-echo technology, which would be nice at conferences, but a part of me is still too vain to get something obvious.

we'll see how it goes, anyway, but thanks for this post and the resulting conversation.

Just started reading your blog, and came across this... (Might be a bit old, but hey, it's relevant to me and not a month-old moldy post.)

As someone who was affected by rubella while still in the womb (Mom still blames herself for getting it,) I've got moderate to severe impairment to both ears from birth. Wore analog BTEs from year 2, and went digital BTE at, oh, 16ish. 3 years ago, I went in for an audiogram and was dismayed to hear that I suffered a marked decrease in what hearing I had. (Of course, it wasn't a total suprise--my left ear was pretty bad by then.) So I went to a set of ITE canal Magnatones at 1.5k$ an ear--that set me back a fair bit, even when I was working. And I gotta tell you, at first they helped tremendously, but as the years went by, I seem to get a bit less out of them. I don't get any use out of the secondary modes except to listen to misic (and even them I use a decent Radio Shack total ear set and play with the settings to get the best out of them.) My left ear is prolly dead by now, as it started last year and now it's just a 1.5k$ ear plug that I don't even bother putting a battery in it anymore.

So why am I rambling?

Because these Magnatones are my last step before cochlear implants, and I have my significant doubts about them. Obviously as stated above, once an implant is it... they're in for life. You mentioned in a blog earlier about the difficulties about wiring the brain up with computers; this is similar. As an elder member of Generation Y, I do embrace upgrades and the occasional hardware replacements (as my home computer benifited from just recently--and cheaply, compared to hearing aids.) It's an enormous risk for me to trust an implant that will no doubtly become obsolete in, say, 2 years after the operation. The urge to improve one's hearing is a strong force in this one, but there's a line that I choose not to cross until I'm satisfied with the technology.

So, for now, I'll stick with my aging Magnatones and hope that the studies on regenerating gunea pig cochlear cells bears frution. I trust biotechnology will get somewhere in the next decade, and watch those frontiers with what limited senses I have on the ol' Mark I model.